復健科住院實施論病例計酬支付制度之初探

The Study of Case Payment System for Hospitalized Rehabilitation Patients

鄧復旦(Fuk-Tan Tang) ； 劉大任(Da-Ren Liu) ； 陳柏旭(Pai-Chu Chen) ； 白佳原(Jar-Yuan Pai)

《中華民國復健醫學會雜誌》 28卷2期 (2000/06) Pp. 77-85

摘要

隨著國人平均壽命之延長，疾病型態已逐漸由急性病轉為慢性病。復健醫療在健康照護體系之地位顯得日益重要，費用支出也大幅增加了。目前國內之復健醫療給付是以論量計酬制，在抑制醫療費用上漲的效果有限。因此，發展一套適用於復健科住院醫療之付費方式，是當前保險機構與決策者努力的方向。嘗試使用論病例計酬制來訂定支付標準，並且利用生活功能獨立執行測量表來建立償付費用系統似乎是未來可以發展的趨勢。
本研究探討了臺灣四家醫療院所復健科之腦中風住院病患在住院中的醫療花費。依照現今之健保給付下，我們計算了這些病患之住院平均總費用、復健費用以及平均每日費用。另外，本研究也比較了梗塞性中風與出血性中風的復健治療費用。
結果顯示：甲醫院平均總費用為122,864元，平均每日費用為2,918元，復健治療費為27,406±15,412元。乙醫院平均總費用為98,467元，平均每日費用為2,524元，復健治療費為37,053±16,961元。丙醫院平均總費用為84,457元，平均每日費用為3,594元，復健治療費為14,065±11,464元。丁醫院平均總費用為116,526元，平均每日費用約為5,044元，復治療費為16,482±13,565元。在中風診斷方面，梗塞性中風之復健治療費用為26,353元，出血性中風則為24,583元。若以全部樣本來看，不分醫院與中風診斷類別，所計算出來的平均總費用為110,124元，平均每日費用為3,146元。
本研究顯示各家醫院之費用差異頗大，其中所牽涉的影響因素相當的多。所以依照中風患者單一次住院費用來訂定復健科腦中風住院病人之論病例計酬制度之費用給付並不合理。

關鍵字

生活功能獨立執行測量表 ； 論病例計酬 ； 復健 ； 梗塞性中風 ； 出血性中風

並列摘要

With the increase in average life expectancy, the disease pattern has gradually changed from an acute one to a chronic one. The rehabilitation care has played an important role in the care of chronically ill patients. The number of patients seeking rehabilitation help has increased tremendously after the implementation of National Health Insurance (NHI). The legislators and administrators are trying their best to develop a more suitable payment system in Taiwan for controlling the increasing rehabili-tation related medical fees.
After reviewing related articles, we have discovered that it is necessary to develop a case-mix system for inpatient rehabilitation before any appropriate payment system can be implemented. The future trend would be to apply the functional independence measurement (FIM) to inpatient rehabilita-tion. The rehabilitation centers are then paid according to patient’s functional gain.
This study also calculated the total average medical and therapeutic fees for hospitalized stroke patients. The average medical fee was approximately NT$110,124 (NT$80,023-NT$122,066), while the average therapeutic fee was approximately NT$27,406 (NT$16,482-NT$37,053). These data can be the references for prospective case payment rates to be implemented by the NHI.

並列關鍵字

functional independence measurement ； case-payment ； rehabilitation ； ischemic stroke ； hemorrhagic stroke